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Month: November 2012

The big story in Britian’s media this week has been the publication of the Leveson Report into the press. This comes from Lord Justice Leveson’s extensive inquiries into abuses perpetrated by Britain’s newspapers. The newspapers, of course, have been anxious to get their answer in, starting days before the report was actually published. But bloggers have been diving in as well. I have neither read the report, nor all this commentary in detail. But stepping back, I find something rather striking. Mostly the arguments are made on grounds of high principle. If only life were that easy.

Critics focus on the report’s recommendation that a new regulatory regime for the press should have “statutory underpinning”. This is taken to mean state regulation, and even state licensing of news publications. And this in turn runs against the sacred principle of freedom of speech and freedom of the press. So supporters of the report’s recommendations are attacking a free press. This argument is pushed by the usual suspects in the press itself. But not just them. There is Lib Dem blogger Stephen Tall, for example, supported by the Facebook site Vote Clegg Get Clegg.

Most Lib Dems, though, support their leader Nick Clegg’s backing of the report. For them the sacred liberal principle is the protection of the weak against the unaccountable power of the press. Pres self-regulation has been tried so many times and found wanting that something stronger is required, they say. “Do it for Milly Dowler,” they say referring to one of the most egregious episodes of press abuse. They think the promise by newspapers that this time it will different is just a cynical ploy, so that they drift back to their old ways when the dust settles. They have form after all.

I was planning to take sides in this debate – and in support of the report’s full recommendations. Most of the arguments against are pretty specious. I don’t think freedom of the press is being attacked in any meaningful way. The accountability of the press to its readers, who may always refuse to buy newspapers, doesn’t work either. Unfortunately the readers are part of the problem. And the idea that we shouldn’t attempt to regulate the press because the scheme ignores the internet is a classic red herring. Behind this lies my intense dislike of the baleful influence of many newspaper publishers on political debate, to say nothing of the cynical disregard they have members for the public.

The fact is that running a liberal society is a balancing act, much though we like to think of it as being the upholding of high principle. Freedom leads to abuse: people will always try to use it for the purposes of harming others. There have to be laws and regulations to limit the damage – but it is rarely clear exactly where the line should be drawn. But it is clear that we all have to put up with a certain amount of abuse if the regulatory framework is to do more good than harm.

This is painful. I find this especially so in the case of politics. The British press consistently puts about lies and half-truths in order to further their sponsors’ own political agendas – or simply because it encourages people to buy papers. This overwhelmingly favours political conservatives. But there really isn’t much that can be done about this. Regulation of broadcast media is quite successful – but the press is quite a different matter. Regulation, if we have it, must focus on the rights and privacy of ordinary members of the public – and not politics.

It follows that any regulatory solution has to be a messy compromise, whose effectiveness turns on tiresome details. Trying to derive your views by basing them on high principles doesn’t work. The Prime Minister, David Cameron, opposes the “statutory underpinning”. This is no doubt a political calculation, as the Conservative Party depends heavily on the press to do a lot of its dirty work – the sort of negative campaigning that would be done by paid advertising in the US. But one point he made did strike a chord. He said that any law to implement the recommendations would be highly complicated, and probably not worth the trouble.

He may be right. The power of the press is fading. Newspaper circulations are falling. Old fashioned press barons are slowly being replaced by faceless, calculating corporate types. People rely on newspapers less and less. They are being replaced by a combination of broadcast media and internet outlets. That brings its own problems. No doubt the press’s behaviour has helped to hasten its demise. What is good for short term sales can damage long term results, like sliced bread or lager.

That’s probably for the best. But please, liberals, don’t pretend that this debate is all about sacred principles.

The elephant in the room, referring to an issue everybody can see but won’t talk about, is one of our most irritating cliches – almost as bad the perfect storm, used to mean trouble on more than one front. So I am employing the elephant’s slightly less tired cousin, the gorilla, in a shameless atempt to get a more interesting headline. I want to talk about the politically unmentionable fact of London’s local government: its borough system is not fit for purpose.

Local government in London is the responsibility of 32 Boroughs, plus the oddity of the City of London. These boroughs were created in a reorganisation of London’s government in 1963. They were amalgamations of a series of much smaller boroughs, and were civil service creations, designed to carefully balance income from rates, the taxes then charged on both business and residential properties – and which funded a large part of each borough’s activities. Inner London districts, like Vauxhall, were paired with leafier areas like Streatham. There was little or no attempt made at geographical coherence. They were more or less random collections of London’s villages, with boundaries often ignoring even these (Balham is split between Wandsworth and Lambeth, for example; Wimbledon between Wandsworth and Merton, and so on).

Geographically incoherent and designed for a defunct system of local taxes: not a promising start. But that is not the main problem. Fifty years after their creation they are clearly much too small to deliver most of their services efficiently. I have had the same conversation with a number of different people working with local government in a number of different parts of London. They all agree that the boroughs are much to small to be effective, especially in the areas of social services and education – but also in general administration. But politicians won’t talk about it.

Two problems are coming together. First is critical mass and economies of scale: there is excessive duplication at senior and administrative levels, and loss of flexibility in the deployment of staff. Then there is geographical incoherence: problems often cross boundaries. I can see this clearly in the area that I have most to do with: education. Even at primary school level: there is a crisis of lack of primary places locally; it is worst at the borough’s boundaries – and yet officials are loath to consider new schools where a lot of pupils will come from another borough. The problem gets worse at secondary level – and it is an absolute joke at tertiary – where the colleges boroughs are responsible for service much bigger areas than a single borough.

The efficiency argument is getting a little bit of political attention. The government is encouraging boroughs to merge departments with neighbours. This is being advanced by the tri-borough arrangement of Westminster, Kensington & Chelsea, and Hammersmith & Fulham. But this is ad-hoc and awkward, since the councils themselves are being left intact.

But as well as the boroughs being too small, they are too big. A local sense of place is already quite weak in London. Such as it is works by “village”, whose boundaries can be hard to see, but which each have a distinctive centre, often based on an ancient village that was once rural. The borough feels remote and arbitrary by comparison – with residents often feeling that their area is neglected by councillors and officials.

Too big and too small at once. Perhaps there is little surprise that politicians are staying clear of the issue. But it is worth thinking about how it might be organised more sensibly. I want to do this in the opposite way to a classic civil servant: from the bottom up. This starts with the villages. These need to be defined as the basic unit of local government.

My starting point for identifying local villages would be the good old postal districts. These were designed in 1917 by the Post Office, without regard to parish or civil boundaries. But they seem to have known what they were doing, and it is easy to attribute a village name to each district (SW11 = Battersea; N1 = Islington, and so on). They have also become a badge of identity in their own right. This won’t always work, and they get a bit dodgy around the edges, but think this gives a broadly viable size. One thing that should be disregarded is current ward boundaries. Wards are designed to be of even population size within a borough – which means they disregard commonly understood village boundaries.

These village should then be grouped into a smaller number of boroughs. Geographical coherence is probably not a realistic objective here – though it makes sense to broadly accept the Thames as a boundary. There should be no fetish about exactly equal size, however. How many? There are two current models. There are six NHS PCT clusters. This would be the radical version, and sort feels like the five boroughs of New York. The less radical alternative would be the 14 constituencies of the Greater London Assembly. This feels like a better balance between Greater London overall, and and the villages.

So how would the two tiers work? The heavy lifting, including all contracts of employment should be at borough level. The main function of the village level would be scrutiny and coordination. But the villages should lead on the critical area of planning. Things like licences for pubs should be decided at this level. Following the example of what goes on outside London, residents could elect councillors at both levels: principal local authorities and local town or parish councils.

But amongst those that have worked with such things there is almost no enthusiasm for separate town council elections. The general level of political apathy may make it difficult to sustain in many areas – and it is a recipe for friction and conflict. A much better idea is for the principal councillors to do both jobs. The borough would form village committees of the councillors elected in each village. This is the neighbourhood committee system which operates successfully in Liberal Democrat boroughs such as Kingston. This places some constraints on size. You would need, say, a minimum of six or seven councillors elected in each village. Let’s say there were 120 to 150 villages across London: that would maybe 1,000 councillors. With only six boroughs you would have an average of about 170 councillors in the principal authority. With 14 you would have a more manageable 70 or so. The best way of electing the councils would be one multi-member ward per village, elected by proportional representation (STV or party list). You would simply vary the number of councillors in accordance with the population, without the need to keep reviewing boundaries.

Well that’s enough to start with. I haven’t even mentioned taxes and debts. But the point now should be to start talking about it. Surely this would be a more efficient and effective way of running the capital? It needs to get on the political agenda. Probably the next step would be for a think tank to take the idea on, and then start drawing in politicians from across the political spectrum. Time to talk to the gorilla.

“We have some explaining to do,” said Rowan Williams, the outgoing Archbishop of Canterbury, after the General Synod of the Church of England failed to endorse the ordination of women by the requisite majority. That is certainly true. Many English citizens, practising Christians and not, and in total despair about whole purpose and meaning of the church.

One thing struck me immediately about Dr Williams’s televised statement. After saying the Church had some explaining to do, he went on to point out the reasons why he thought women should be admitted as bishops. They were all pragmatic, having to do with the need to reflect the wider values of society, and its ability to influence those values. This was a bit of a shock. I had thought that religious bodies made such decisions on the basis of high principle. If it is the right thing to do in Christian terms, then do it. Or not. The Roman Catholics, at least, show much greater clarity in such things. They heroically plough on against the values of wider society because they believe that is God’s path. The CofE’s path bespeaks a certain hollowness at its heart.

It also shows something about the toll arguments about the role of women, and indeed gays, has taken on the institution. I was brought up in a Church of England household, was confirmed and a regular churchgoer until I was 21 (in 1979). At university I was a member the Christian Union, though not entirely signing up to the full Evangelical credo – I never could take the literal truth of the Bible, for example.

In the 1970s arguments about women priests raged. My mother, a senior clergyman’s daughter and brought up on a cathedral close, was a passionate supporter of women’s ordination, and the whole family followed her. But there were antis at our rather anglo catholic (at the time described as “high church”) local parish. I remember arguing furiously with our curate – he held the view that it was impossible for a woman to be a priest since the Christian image of God is male.

This was an instance of the anglo catholic view. This line of thinking places huge emphasis on the church’s traditions and history, and thinks that sweeping them away drains the faith of meaning. They have rather ambiguous feelings about the Church of Rome – but they feel that the Church of England’s ultimate destiny should be to reunite with it. This group is fading in its importance. It has failed to capture the imagination of the young. It has been fatally undermined by the defection of so many of its adherents to the Roman Catholic church. The Romans have maintained a more dynamic balance between tradition and modernity, and are fundamentally more appealing to the traditionally minded. The more mystical and less intellectually tyrannical Orthodox church also appeals.

The most important part of the blocking minority in the Church of England is now a group that describes itself as “conservative evangelicals”. I know very little about this group. The evangelicals that I knew at university were different and more mainstream – a group from whom the next Archbishop of Canterbury, Justin Welby, is drawn. I have seen them described as inspired by American thinking – and their use of the word “conservative” to describe themselves rather lends support to this. It isn’t a hurrah-word here, even among conservatives. They are sceptical of many ancient church traditions, and treat the Bible as their main source of authority. They seem have a strong, nostalgic and paternalistic outlook. They do not object to women bishops as such – they just do not want to be in a position where their congregations have to accept one.

What is this institution over which these factions are arguing? It is deeply embedded into English life and the unwritten British constitution. Most English use it to mark the big life events of birth, marriage and death. It is the source of pretty words and beautiful old churches. They lustily sing Christmas carols and sigh at children’s nativity plays. The CofE is deeply identified with the country’s lingering identity with the Christian faith. It is a bastion of civic society, as church members carry out social work in the wider community, and even reach out to those of other faiths. The English have mainly stopped going to church but they would no more abolish the Church of England than they would the Queen or the first-past-the-post voting system, other traditions that have long lost their intellectual coherence.

But for practising Christians this is hollow. The ultimate purpose of the Church should be to bring people into the faith, and here it has failed. Now it is failing even to define what that faith consists of, as it comes a loose association of incompatible understandings.

The hope among some, such as Dr Williams, was that there was enough common ground for these disparate groups to sustain a joint community – and then use the platform provided by the Church’s national status to draw more people in.

I don’t find this such a silly idea. I think at the heart of the Christian gospel is a wonderful set of ideas that are still capable of drawing people in – myself included. Love, forgiveness, redemption, equality, embracing the disadvantaged. They are as fresh today as when Jesus first preached them. If only practising Christians could agree to talk about just these in public, and agree to differ on everything else.

But no. Christians are obsessed with abortion, gays, the ordination of women, the literal truth of the Bible, heaven, hell and a host of other peripheral things where the church’s teaching fails to resonate with our modern understanding of how the Universe is. The Church of England has lost so much time and energy talking about such things that they have no energy left for anything else.

Personally I think it would be right for Parliament to save the Church from its constitutional mess – and then hope that the new Archbishop, who shows some signs of promise, starts to put some meaning back into its hollow heart.

The Gaza Strip isn’t a big place. You can walk across it in an hour or so. I know because I’ve done it. That was in 1979.

I had just graduated, and a group of us from Cambridge were volunteers at Kibbutz Be’eri on the edge of the strip. The kibbutzim largely ignored their neighbour, but we were curious, and talked about visiting it. One of the local Israelis suggested that we’d have our throats cut, but mainly I think the reaction was “What do you want to do that for?”. We dithered. Then one morning two of the girls in our group had enough and went on by themselves to the checkpoint nearby to walk into Gaza City. Half a dozen of us others decided that that was where they had gone, and that we had better follow them. And we went to the checkpoint, and walked all the way up to the beach, finding the two girls as we did so.

We were made to feel welcome, including the Jewish lad amongst us who did not conceal his Star of David pendant. I don’t remember much about what the Palestinian locals said, but we did meet at least one radical PLO type. I remember most clearly a lad on the beach asking me to “Tell them at home how it is here.”

How was it? It was a forgotten corner where stateless people lived, largely in poverty, and without much hope. But they were human beings like us. A lot has changed since, but not those essential characteristics.

I didn’t really fulfil that young man’s wish, certainly not in public. I have avoided saying much at all about the Arab-Israeli affairs. Opinions are so polarised that few would care to hear what I was actually saying, just try to decide whose side I was on.

Whose side are you on? That’s where the Israeli narrative starts. The world is divided between an “us”, the Western societies of Europe and America of which Israel is a part, and a “them”, assorted Arabs, Iranians and other Islamic nations, who wish “us” ill, and with whom we share little in terms values, culture and outlook. I’m sure that’s how most Israelis see the world, excepting those for whom “us” can only be Jews. It’s a view that seems to be accepted in America too. In Europe we struggle with it, having learnt, the hard way, that model of the world really won’t do.

And after that we get into a tangled web of claims and arguments. The Israelis ask, quite understandably, “What would you do if a neighbour kept firing rockets at you?” We have very little conception as to how we answer that question. It’s of quite a different order to the various terrorist threats we have faced in our own countries. Kibbutz Be’eri lives on, but under constant threat. In 1979 security was very discreet, and the sense of threat only in the far background. These Israelis did not gratuitously flaunt their weapons, as so may Israeli and Arab men do, then and now.

The rockets aren’t pocket terrorist weapons, they require a degree of state organisation to support, especially the bigger ones. Israelis must feel that Gaza civilians are to some extent complicit in allowing this to happen.

And the Palestinians point to a long history of injustice, which passes completely unrecognised in Israeli political life. They feel that all means of progressing their cause other than violence have been blocked. The Israels just want them to keep quiet so that they and the rest of the world can forget they are there. Again we can have no idea about the depth of frustration they are feeling – just as we cannot understand how random violence against the innocent is any way to progress your cause.

Both sides are in a bind. Hamas is spoiling for a fight, and they seem to be daring the Israelis to invade, so that they can bog them down in a horrible war. The Israelis know that a military solution requires just such an invasion. Both sides may draw back, but no ceasefire will tackle the fundamental issues that divide them.

Both sides seem addicted to the use of violence as the way to solve their problems – which only reinforces that conviction in the other side. Any individual leader, on either side, that tries to break free from that logic risks being undermined by those that disagree. I am a political optimist generally. But not here.

Speaking at a Lib Dem conference in the Coalition’s earlier days Linda Jack, a Lib Dem activist, called for a commitment to “evidence-based policy”. She was interrupted by strong applause from the floor. Ms Jack is a feisty activist, but is not known for thought leadership. Her use of the idea, and the applause she got for it, shows that evidence-based policy has become a mainstream idea in some liberal circles. Not long ago it was a rather abstruse, fringe idea pushed by academics who wanted the extra public funding that it would require. Why is it now hurrah phrase used by political activists? Is this a good thing?

But first, what is it? No many people just think that it means that any public policy idea should first be based on some kind of evidence that it works, rather than just sounding like a good idea. But, to those that take the time and trouble to advocate it, it in fact refers to a particular type of evidence: statistical studies comparing the effects of the policy in action against some kind of control group. It takes its inspiration from medicine, and, indeed, some of its strongest advocates, like the writer and journalist Ben Goldacre, and Lib Dem former MP Evan Harris, are medical doctors.

Evidence-based therapies are all the rage in modern medicine. Statistical evidence techniques have long been used in drug trials, but their use is widening to other areas. It forms the core of policy advice put forward by Britain’s National Institute for Health and Clinical Excellence (known as NICE). What is interesting about these evidence-based therapies is their pragmatic element. Treatments are recommended because they are shown to have benefits, even if the explanation is unclear. I am taking medication to reduce ocular pressure, because ocular pressure seems to increase the risk of glaucoma. My consultant told me that why this was so was not understood – the treatment was prescribed purely on the basis of the evidence. Although the technique is often described as scientific, this pragmatism takes it away from classic scientific method – not in the rigour of the testing, but in the lack of a theoretical model to drive the hypothesis. No matter; a lot of useful therapies are being put into use, and some ineffective ones are being weeded out.

So it is quite natural for people to want to use the technique for non-medical areas. An early example of this was the testing of conditional cash transfer programmes in South America in a bid to raise levels of schooling and reduce poverty. A programme would be devised, and participating villages would be compared to ones outside, preferably with a random assignment between the groups. These studies helped make the case for these programmes, which are now a standard part of the anti-poverty tool set, and are credited with particular success in Brazil (the Bolsa Familia programme). A lively academic debate has been provoked as to how useful the technique is.

What are the problems? Most of the debate that I have read about focuses on two issues: the rather limited nature of the questions that you are able to gather evidence on, and the huge difficulties of gathering untainted evidence, especially if it is not possible to do large scale randomised trials, which it usually isn’t. It is disappointing that wider public debate is so limited, though, and evidence-based policy has simply become a warm, apple pie idea, without people asking searching questions as to what it is and what its limitations might be. There is a dark side to it.

This dark side is in fact evident in the medical model. Dr Goldacre has made his name in using evidence-based ideas to expose charlatan claims for fringe treatments that often get uncritical publicity in the press. This is good, but he*, and especially his disciples, swiftly move on to attacking alternative therapies in general. Homeopathy is a favourite target, since its use of extremely diluted solutions defy scientific common sense.

This is an interesting case. I don’t know much about homeopathy, but from what little I do know it places great reliance on three ideas: that you should look at the whole person; that mind and belief are a critical element of therapy; and that every person is an individual. These are three blind spots in statistical evidence techniques. They can only be used to test very simple propositions, so it is necessary to break down the whole person into a limited number of measurable symptoms. It is impossible to distinguish mind and belief effects from the so-called “placebo effect”; the placebo effect often works, but is excluded and ruled out of order by the evidence advocates since it is so difficult to test. And statistical evidence techniques depend entirely on using general rules, and do not attempt to find treatments that will work for everybody. So homeopathy is untestable using evidence-based techniques. That is a problem (how do you spot the charlatans?) but it does not make it rubbish. In fact what the evidence advocates are trying to do is to impose a particular belief system on what should and should not be included in health therapies. There is a world of propositions that are testable by statistical techniques, and a world that is beyond their scope. Both are big and important.

And what about evidence-based policy? The idea is bandied around very loosely by political activists, and most have very little understanding of the full implications of the technique or its limitations. Why are they so keen, then? At first I thought it came from the habit of politicians (including, and especially, the “non-political” sort) of using loose statistical associations to support their advocacy – to try and give themselves more credibility. This happens: I see much nonsense around the wisdom or otherwise of the government’s policy of converting schools into academies free of local authority supervision. But the cover was truly blown for me when I saw Dr Harris at a fringe meeting at the recent Lib Dem party conference. This was on the government’s “Free Schools” policy. Because of the difficulties of gathering evidence to test any policy proposal, he could knock any proposal down at will on the basis of lack of evidence. It is a powerful weapon with which to defend the status quo (which, of course, you do not need to test…).

Evidence-based policy, in the limited sense that its advocates use, is no doubt a useful tool, but of quite limited value in practice. We need to broaden our idea of what constitutes proper evidence, and develop an understanding of where good old-fashioned human judgement and instinct is more appropriate, given its speed, responsiveness and ability to handle both complexity and individual variations.

* Dr Goldacre is very careful in his use of words. His actual attack on alternative therapies may not be as direct as I am implying. He is, rightly, more interested in challenging false claims about evidence than in challenging therapies that make no such claims, but where conventional evidence is lacking. This not true of many of his fellow travellers – I have read much mockery of homeopathy online.

The British political and media establishment hunts in a pack. They pick one issue, everybody attacks it at once…and then they swiftly move on to the next. There is no time for proper critical analysis, or maintenance of aim over any period longer than a few days, sometimes just hours. This has been evident over the recent media scrum over the BBC and child abuse. First it emerged that celebrity DJ the late Jimmy Savile was up to no good in the course of his work, some years ago, at the BBC. This raised some deeper issues about the management of these sorts of risks at both the BBC and elsewhere. Before any serious reflection could take place on that, though, the pack had moved onto the editorial decisions of the BBC Newsnight programme when it dropped an investigation into Mr Savile in late 2011. Then came another Newsnight investigation into a long past scandal at a Welsh children’s home, which supposedly implicated a then senior member of the Conservative Party, who wasn’t named. The individual concerned, who was quickly outed in the usual social media, then counterattacked, and it quickly became clear that the allegations against him had no basis. The pack moved onto the role in this of George Entwhistle, the BBC’s Director General (DG) of less than two months. After a particularly aggressive interview on BBC radio by John Humphreys, Mr Entwhistle was considered dead meat and duly resigned. Briefly the pack went onto the question of the BBC ‘s cumbersome management structure, before, this morning, focusing on Mr Entwhistle’s severance terms. Each of these issues deserved more considered analysis than it generally got, although a few thoughtful articles were published (like this one from the FT’s Philip Stevens – behind paywall). The issue of how the BBC should organise itself is a particularly difficult and interesting one, though. This blog is a lone wolf who only occasionally hunts with the pack, so I make no apologies for backtracking a bit to give it a bit more thought.

First, the health warnings. I have very little experience of the BBC except as a consumer of its output. I have never worked in a media organisation. But as a manager I have a lot of experience in the design of organisation structures. There is a tendency for introverted managers like me to put too much weight on organisation charts, which we can play with to our heart’s content in private, at the expense of other vital organisational elements, like strategy and culture. But they are nevertheless very important.

In the BBC’s case, the general accusation is that it has too many layers of hierarchy; it is also said that it is too complex, which probably means elements of “matrix management” and multiple reporting lines. At the end of a BBC comedy News Quiz a couple of weeks ago, the programme writers made this point by adding into the credits all the managers responsible for the programme up to Director General. It was a long list (including heads of comedy, Radio 4, Radio broadcast, etc.). The BBC Trust’s Chairman, Christoper Patten, voiced his frustration at the sheer number of managers at the BBC. This, it is said, diffuses responsibility for any given decision, allowing poor decisions to go unchallenged; either that or there is excessive challenge and innovation is stifled.

But this type of structure is quite typical of large organisations dealing with complex processes. Indeed it can be seen as the common sense way of organising things – the sort of structure most people would come up with if they were asked to organise things. This was illustrated wonderfully when a former BBC Chairman, Michael Grade, was interviewed. What Mr Entwhistle had lacked, he explained, was a deputy specifically responsible for keeping an eye on BBC journalism, and moving to head off trouble, or at least alerting the DG of trouble ahead. The problem wasn’t that Mr Entwhistle had too many managers, he seemed to be saying, but that he did not have enough.

And, of course, that is exactly how such structures come into being. If you have a particular problem or challenge, you create a management position to own it and give it due focus. And so organisation structures grow. This can work, but it usually doesn’t. It is rear-view mirror driving, and can create so many conflicting tensions that organisations seize up. Both of these problems can be overcome by the right sort of leadership at the top – which indeed is what Lord Grade also suggested. Somebody who can cut the c**p and short-circuit the structure when required. But this did not seem to be Mr Entwhistle’s management style, whether from inexperience or natural preference, he seemed to want to let his managers get on with their jobs. This gives another clue as to the endurance of manager-heavy organisations – they suit big egos at the top. They also offer lots of promotion paths to people further down the organisation.

So multi-layered management is common sense, and can work with firm leadership from the top. That does not make them efficient. The alternative is known as a “flat” structure, from how it looks in a classic organisation chart. There are fewer layers of organisation (five is not untypical from cleaner to Chief Executive, perhaps seven in a very big organisation), but each manager has more other managers, on average, reporting to them (say from three to seven or eight). This requires many less managers. But it also requires clarity, vision and managers who don’t mind acting on initiative, and other managers who don’t mind it when they do.

How might this work for the BBC? To my inexperienced mind the obvious way to go would be to organise it into a series of separate brands aimed at particular audience segments, and each given a number of television and radio channels, and then give each head of brand a lot discretion how and what to deliver through the channels under their control. BBC News would probably best be treated as its own brand, even if most its distribution would be through other channels. There would be some technical functions too, with generally lower organisational status. Duplication and clashes between the brands would be tolerated.

But this does not sound very BBC. We like to think of it serving the nation as a whole – and duplication looks wasteful, even if in the long run it isn’t. But maybe it would force the BBC to sharpen up its idea of who it is trying to appeal to. That is appropriate in a multi-channel age.

But without that type of customer-centred organisation you are forced into something functional, which would soon resolve itself into something very similar to what it is now. And no doubt that is what will eventually happen. A few managers will be knocked out; and a few multiple reporting lines removed, amid claims of radical change. But the underlying tension causing the complexity wouldn’t have been dealt with.

The BBC is a wonderful institution. Its news brand is somewhat tarnished, not just by these recent episodes, but by sloppy reporting generally. And, as Philip Stephens suggests, it is perhaps too beholden to celebrity presenters. But it’s still the best there is on TV and radio. And at least this episode shows that it can report objectively about itself (how unlike the Murdoch empire’s papers). It won’t be the end of the world if it does not have the courage to reorganise itself properly.

I do not advise citizens of other countries how to vote. It’s very bad manners. But there’s something very striking about viewing today’s US elections from outside that country: how few foreigners support the Republicans.

This is unsurprising amongst my own contacts and Facebook friends – they are largely Liberal Democrats, with the odd Labour supporter. In the US these would be well within the Democrat family, with an outlok that largely fits the American understanding of the term “liberal”, a dirty word to Republicans. But a number of opinion polls show that support for the Democrats is widespread right across the world. In this instance Britain is very much at one with the rest of Europe, rather than part of some Anglo-Saxon block that some Britons suppose exists.

It is not immediately obvious why this should be so. It is true that Republicans are generally more socially conservative that those outisde America, or those that are politically aware, anyway…but that really is the Americans’ own private business. Mitt Romney is a perfectly intelligent and plausible presidential candidate, when looked at objectively, with much much more experience in getting things done than has Barack Obama, in the public sphere as well as in business. Furthermore, the Republicans believe in strong U.S. armed forces, something that the rest of the world has been free-riding off for a long time, though we might not like to admit it.

So what’s the problem? Perhaps it is economics. The Republican attitude to the US financial state defies mathematics – to think that its massive fiscal deficit and national debt can be tackled without rasing taxes. But I’m not sure how much people in other countries understand this debate. Something deeper does lie behind it though: the belief that the state should provide a minimal social safety net if anything. The idea of a welfare state is pretty much consensus in Europe, so this is a clash. Republican Americans are convinced that Europe is a basket case as a result – though things look different to us. To the extent that we think about the US, we would worry about the breakdown of social cohesion as a proportion of the population gets stuck in an underclass. But I don’t know how troubled Europeans are about this really. And non-Europeans may well be more sympathetic to the Republican view on this.

I think there is soemthing bigger going on. We associate the Republicans with a particular world view that combines a sense that the US has a wider mission in the world with an almost wilful ignorance of what is actually going on. Many Americans feel that it has carte blanche to interfere in other countries’ affairs to protect their interests and advance their view of civilisation. But that does not seem to imply making any attempt to understand the complexities of what is happening in the rest of the world: simply dividing the world into good guys and bad guys. Everybody will have some example of how this paradox has led to injustice and suffering. It might be George Bush’s “War on Terror”, or the Iraq war and, especially, its aftermath. Or else it is an unquestioning support for Israeli government policies, on little more than the idea that they are “people like us”…a situation that is drawing the world ever closer to a war with Iran.

Democrats get credit for trying a bit harder to understand to understand and respect the rest of the world. Bill Clinton and Mr Obama stand in clear contrast to George Bush Junior. Mr Romney’s campaign has not reassured non-Americans that he is any better than Mr Bush – though I personally believe he is head and shoulders above him.

There is an asymmetry about all this. America appears on our TV screesn and cinemas every day. American news is world news. A lot of people outside America feel that they know about America, even if they actually know a lot less than they think. But it is not true the other way around. Few Americans seem to care about the world outside their country, except to the extent that it is a nest of vipers posing a threat to their wellbeing. Fewer still will care what the rest of the world thinks about their election.

And yes, I too hope that Mr Obama will win, though I’m not as scared as many are of Mr Romney. I also hope that the Democrats will hang on to the Senate, and do well in the House of Representatives. Except that a small part of me wants the Republicans to win all three elections, and so have nowhere to hide from the impossibility of their policies, so that a t last America can start to move on.

Last Monday, three days ago now, I lay, conscious, on an operating table at St George’s hospital, Tooting. A tube had been inserted into my artery in the right arm at the wrist, through which dyes and then wires were inserted. On my left wrist a drip had been inserted into vein so that drugs could be injected rapidly. Two surgeons were doing their stuff around the area of my legs, looking up at two monitor screens. A large cylindrical device was being pointed at my chest at various angles. I lay as still as possible, as the surgeons exchanged comments and gave occasional orders to technicians outside the room, who would respond over the intercom. Some music was playing quietly in the background.

The surgeons were doing an angiogram. They were pumping dye into my bloodstream to make the blood flows visible through an X-ray camera and spot any problems with the blood flow to my heart. And they did find a problem. “One of your arteries is completely blocked. This almost certainly caused your heart attack,” one of the surgeons said to me, “We want to insert a piece of wire to clear it.” I consented. The surgeons then completed a procedure known as an angioplasty. This involved using a piece of wire pushed through my arteries to insert an stent, a small length of tube, into the blocked bit to open it up, after first inflating a small balloon to create the space.

It was really only then that I fully realised what had happened – that I had indeed suffered a heart attack, and that as a result my life was in the hands of these two surgeons and their team. Until then I had thought the problems might be some sort of viral attack (as my elder brother had suffered a few years before) with few longer-term implications. The previous evening, my family visitors remarked on how well I was looking – though the medically literate among them could spot the abnormal trace on the heart monitor that I was wired into. This is a shock. I had no indication until then that I was at risk. I take regular exercise; I’m not overweight; I have never smoked; I eat my five a day; I even make sure I have a couple or more portions of oily fish a week; my blood pressure has always been normal; no tests that had been run on me had shown me with anything other than a very healthy heart. It really can happen to anybody.

The problem seems to have started over two weeks beforehand, while we were on an organised tour of Sicily. One night, after dinner, and a day when I had felt slight constrictions to the chest area, I started to suffer acute chest pains. I couldn’t sleep. Eventually, at about 3 or 4 a.m I took some aspirin, and the pain subsided and I got some sleep. I was puzzled at what had caused this episode. The chest pains pointed to a heart attack, but none of the other symptoms did. I wasn’t breathless, I could carry out normal physical activity. As the pain subsided, the idea that it was severe indigestion took hold. Gavascon seemed to help with the contuining mild episodes of pain. The local diet can be pretty acid. The day after the attack I had no trouble in climbing to the top of a stone tower to get a wonderful view of the western Sicilian coast. The next day, though, I felt lethargic and a bit feverish, collapsing into my hotel bed for an afternoon; but a couple of days after that things seemed to return to normal. We continued with the tour, returning home at the end of the week.

The episode has was scary enough for me to go to my GP in the week after we returned. I probably wouldn’t have done this had my wife not insisted on it, though I had noted that my fitness at the cardio-vacular exercises in the gym had fallen rather sharply. My GP tended to agree with my diagnosis of acute indigestion, as he would have expected that a real heart attack would have had more of an impact. But he did recommend that I did some blood tests. This I did last Friday morning, at 8.30 a.m. By midday my GP had rung me to say that one of these tests had revealed a high troponin level, indicative of heart problems. He recommended that I go to St George’s A & E to get an ECG (electro cardiogram – where they put a dozen electrodes on your skin and get traces of your pulse). This I did straight after lunch, expecting to be home for tea. But the ECG showed an abnormal trace. I was admitted to hospital, hanging around in A & E while a bed was cleared. The next step was the angiogram – but that couldn’t be run until Monday. Meanwhile I was kept under observation, with a cocktail of drugs administered by tablet and injection.

Now I am at home in rehab, recovering from the damage to my heart from the blocked artery, and the operation itself – but the prospects for a full recovery are good. But I’ll be on pills for a long time, probably for the rest of my days. At the moment there are six different sorts of pill, but it should come down to less than that after a year. My fitness regime will have to be adjusted downwards so as not to place too much strain on the heart. I am quite lucky though, first that the original attack did not do more damage, and second that the problem was picked up before the blockage to my artery caused more damage to the heart and maybe a more serious attack.

Why me? I don’t hit any of the main risk factors – except that I was not avoiding cholesterol in my diet. In fact I was a heavy cheese eater, and relished meat fat and chicken skin. That will now change. But some peple are just more at risk than others. My physical fitness may have helped reduce the effect – though a bit too well if it had meant that I had avoided having it checked out.

It is customary at this point to praise Britain’s NHS and scorn its critics. I will try and be a bit more objective, after my close observation of the service at work. But it doesn’t come out badly.

Firstly I am immensely grateful to all those many professionals that helped me through the episode. I always felt that they had my interests at heart and they did their best to help me. Nurses, doctors, technicians, pharmacists and surgeons – I can’t fault any of them. I now have very benign feelings towards St George’s hospital, which happens to be my local one – from being a rather anonymous presence beforehand.

Second I cannot fault the overall effectiveness of what the NHS acheived. From the point of that blood test a system was quickly kicked into action that was appropriate at every step, acheived the right outcome, while managing the risks properly. And at points the service was better than good. The surgery was world class; the briefing from the cardiac rehab nurse afterwards was also deeply impressive. The speed with which my blood sample was analysed and acted on was very impressive too.

Effective, yes, but how efficient? Here I was left with a few question marks. I ran into an awful lot of different professionals in my journey, having to repeat my story to up to ten different doctors. This is a warning sign from a process management standpoint – though the need for specialists, 24 hour cover and risk management does not make the matter easy. And there was an awful lot of paper records and documents. It isn’t surprising that there were communication breakdowns; I’m still waiting for my discharge papers. And the whole thing about the service going on hold for the weekend does not feel right either. At least one, and probably two nights of my four night stay were clinically unnecessary. Room for improvement, I would say – and that matters in a tax funded system where overall resources are subject to arbitrary limits.

It is clear though that I was much better off under the NHS system than I would have been under the US one, especially before Obamacre kicks in. I would not have qualified under any of the government funded schemes, and neither would I have been covered by an employer plan. I would either have to to have bought my own insurance plan, which would suddenly have become a lot more expensive. Or I would have to have winged it without insurance, which would have landed me in serious trouble.

But then very few people outside the US think that their system is in any way sensible. A universal insurance scheme, like most advanced countries run, would have caused a little more bureaucracy at the start of my hospital visit, but nothing very burdensome. And I don’t believe that health professionals would be any less caring or professional if they were not working for a state provider. Neither do I beleive that the vagaries of private sector management are any worse than the arbitrary resource management of a nationalised, tax-funded system.

But the NHS did do the job it was supposed to do. And for that I am thoroughly thankful.